AIDS Drug Assistance Program ADAP-Miami. NEEDS ASSESSMENT July 16, 2010

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Dana Elliott
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1 AIDS Drug Assistance Program ADAP-Miami NEEDS ASSESSMENT July 16, 2010

2 ADAP Clients - Gender ADAP Clients by Gender FY 09/10 April 2010 to June % 0% Males Females 26% 0% Males Females Transgender Transgender 74% 74% Note: Figures include eight (8) transgendered clients Source: Bureau of HIV/AIDS 7/13/2010

3 ADAP Clients - AGE ADAP Clients by Fiscal Yr 09/10 60% 40% 44% 51% 20% 0% 0% 0% 3% Lessthan2years 2 12years 13 24years 25 44years 45 64years 65yearsorolder 2% ADAP Clients by Age - April June % 40% 45% 50% 20% 0% 0% 0% 3% Lessthan2years 2 12years 13 24years 25 44years 45 64years 65yearsorolder 2% Source: Bureau of HIV/AIDS 7/13/2010

4 ADAP Clients - Ethnicity ADAP Clients by Ethnicity - Fiscal Yr 09/10 60% 50% 40% 30% 20% 10% 0% 52% 27% 8% 12% 0% 0% 0% 0% 0% 0% Nativ... Asian Pacifici... Black/A... Whitecaucas Multipl... Other Unknown Hispanic Haitian ADAP Clients by Ethnicity - April June % 50% 40% 30% 20% 10% 0% 0% 0% 0% 26% 8% 1% 0% 0% 53% 12% Nativeame... Asian Pacificisl... Black/Afri... Whitecauc... Multipleraces Other Unknown Hispanic Haitian Source: Bureau of HIV/AIDS 7/13/2010

5 ADAP Miami Current Clients as of 07/14/10 Current Open Cases = 3292 Wait List = 143 Source: ADAP database 7/14/2010

6 Requirements & Qualifications STEP 1 STEP 2 DOH PATIENT CARE CORE ELIGIBILITY HIV positive (+) test DOH ADAP PROGRAM QUALIFICATIONS HIV positive (+) test Florida residency Notice of Eligibility 400% FPL Household Income RX for ADAP meds Pt cooperation & truthfulness CD4 & VL ( 6 mo) NO other access to meds NO other access to meds

7 CORE ELIGIBILITY & ADAP QUALIFICATIONS APPLICATION PACKAGE 1. DOH CORE ELIGIBILITY Application form (2 pages/ patient responsibility) 2. DOH Consent to Fax (IF faxing to ADAP-Miami)) SUPPORTING DOCUMENTATION 1. Proof of HIV infection 2. Proof of Florida Residency 3. Proof of Household Income < 400 % FPL - (Paystub, bank statements, income tax, support letter, other, as needed) 4. Proof of NO other access to meds -(Programs, institutions, insurance, others, if needed) 5. Original Prescriptions / ADAP formulary / 6. CD4 & VL < 6 months ELIGIBILITY DETERMINATION & PROGRAM REGISTRATION NOTICE OF ELIGIBILITY ( official date of eligibility determination) AND ADAP REGISTRATION (official date of program enrollment)

8 PAPERWORK BY ADAP TRANSACTIONS TRANSACTION REQUIRED FORMS SUPPPORTING DOCUMENTS First ENROLLMENT CORE ELIGIBILITY APPLICATION FORM DOH 2116 CONSENT TO FAX (IF faxing) Medical Category Form if patient is enrolled on wait list * Proof of Florida Residency Proof of Household Income < 400 % FPL Proof of NO other access to meds Rx s CD4 & VL < 6 months old Re-Enrollment (six months) Drug Updates * DOH 2116 CONSENT TO FAX (IF faxing) * Proof of Florida Residency Proof of Household Income < 400 % FPL Proof of NO other access to meds Rx s CD4 & VL < 6 months old *Rx s REQUIRED DOH FORMS The ADAP program staff in Miami will prepare all the forms required by the Florida Department of Health that need to be signed by the applicant.

9 ADAP-Miami & ADAP-Florida Funding By FY FY Miami Florida % of FL 04/05 $ ,077 $ , % 05/06 $ ,491 $ , % (+$1 422,414) (+5 132,080) 06/07 $ ,462 $ , % (+$ 194,071) (+$2 300,000) 07/08 $ ,078 $ , % (-$1 163,384) (+4 901,039) 08/09 $ ,762 $ , % (-$6 112,316) (+$3,998) 09/10 $ , $ , % (-$2 0829,70.93) (-$5 567,363.31) 10/11 $ 17,489, $ 85,188, %

10 ADAP Cost Containment Measures Cessation of RAMP (Beginning April 27, 2010) Suspension of Hepatitis C Program (Clients who are currently receiving Hepatitis C treatment through ADAP will be allowed to continue their current treatment) Reduction of Formulary (beginning August 1, 2010) Implemented Waiting List (beginning June 1, 2010)

11 New ADAP Formulary (On August 1, 2010 the listed medications will be available to ADAP clients) Beginning June 1, 2010, all new applicants (not reenrollments) must have a prescription for at least one (1) Antiretroviral (ARV) medication on the ADAP formulary to enroll in the program All ARVs + (APTIVUS, ATRIPLA, COMBIVIR, CRIXIVAN, EMTRIVA, EPIVIR, EPZICOM, FUZEON, INTELENCE, INVIRASE, ISENTRESS, KALETRA, LEXIVA, MARAVIROC, NORVIR, PREZISTA, RESCRIPTOR, RETROVIR, REYATAZ, SUSTIVA, TRIZIVIR, TRUVADA, VIDEX, VIRACEPT, VIRAMUNE, VIREAD, ZERIT, ZIAGEN) OPPORTUNISTIC INFECTION (OI s) BACTRIM DS (TMP/SMZ DS) BIAXIN (Clarithromycin) DARAPRIM (Pyrimethamine) DAPSONE (Diamino-diphenyl Sulfone) DIFLUCAN (Fluconazole) LEUCOVORIN (Folinic Acid) MEPRON (Atovaquone) MONISTAT (Miconazole) MYAMBUTOL (Ethambutol) MYCELEX TROCHE (Clotrimazole) MYCOBUTIN (Rifabutin) NIZORAL (Ketoconazole) SPORANOX (Itraconazole) SULFADIAZINE TERAZOL (Terconazole) VALCYTE (Valganciclovir Hcl) VALTREX (Valacyclovir) ZITHROMAX (Azithromycin) ZOVIRAX (Acyclovir

12 ADAP Wait List (implemented 6/1/2010) 143 clients from Miami-Dade as of July 14, Wail List is managed by the ADAP database All new clients and clients returning after a break in services are wait listed. Regular enrollment process is followed with one additional form (Medical Category Form) completed by provider. At time of Wait List enrollment, Client is given Notice of Eligibility letter and Wait List Notification. These may be used to apply for assistance from other programs. Medical Exceptions may be requested by the primary provider. Clients who have not picked up their medications and whose record is closed by and ADAP staff or by the program s automatic closure feature will have to reapply and will be considered new applicants. As funding becomes available, clients with the highest priority category on the waiting list will be enrolled in the ADAP. Source: ADAP Cost Containment Guidance

13 Wait List Categories Category A: Diagnosis of AIDS and /or CD4 <200 cells/mm3. Diagnosis of active opportunistic infection Diagnosis of HIV-associated nephropathy (HIVAN)

14 Wait List Categories Category B Persons who are currently on ARV therapy Persons who were previously on ARV therapy but therapy was interrupted Treatment naïve clients with CD4 cell count between cells/mm3 Category C Treatment naïve clients with CD4 cell count >351 cells/mm3

15 Wait List Exceptions 1. Pregnant women who meet all other ADAP enrollment criteria and are not eligible for other programs. 2. Pediatric or adolescent persons who meet all other ADAP enrollment criteria and are not eligible for other programs. 3. Post partum women (gave birth within 180 days of application) needing to continue ARV medication with medical staff approval (requires Medical Exception Form) 4. Other extreme medical conditions with medical staff approval (requires medical Exception Form) The client s provider must complete and sign the Medical Exception Request Form. When ADAP staff receive the form, it is entered in the ADAP database. If exception is approved by Program Staff, the client is enrolled in the usual manner.

16 Wait List Forms filled out by Provider Medical Category Form Request for Medical Exception Used only when needed

17 Wait List Process Client brings application with Medical Category form to ADAP office.* Eligibility determined. Client entered onto statewide wait list. ADAP staff provide client with Notice of Eligibility and Wait List Notification letters. Local ADAP staff notified when there is opening for client Client is notified within 7 days that there is an opening Client information updated if needed and client is enrolled. If there is no response from the client, the enrollment will be made available to the next client on the wait list. If client does not have a Medical Category Form one will be provided by ADAP staff at time of Wait List entry, to be filled out and signed by provider and returned to ADAP office by client. (source: ADAP Cost Containment Guidance manual)

ALABAMA S ADAP FORMULARY OFFERS 117 MEDICATIONS

ALABAMA S ADAP FORMULARY OFFERS 117 MEDICATIONS - 2014 Alabama s ADAP formulary offers a minimum of one medication from each HIV antiretroviral class approved by the U.S. Food and Drug Administration (FDA).